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'Unprofessional' Behavior Common in Hospitals

Most hospitalists are guilty of at least one instance of unprofessional behavior, a survey showed.

Among internal medicine hospitalists at three Chicago-area academic health centers, about two-thirds (67.1%) said they had nonmedical or personal conversations in patient hallways, according to Vineet Arora, MD, MAPP, of the University of Chicago, and colleagues.

And 62.3% said they had ordered a routine test as "urgent" to get the results quicker, the researchers reported online in the Journal of Hospital Medicine.

More serious transgressions  -  including falsifying patient information and encouraging students to represent themselves as doctors to expedite patient care  -  were infrequent.

"Interventions to promote professionalism should take institutional culture into account and should focus on behaviors with the highest participation rates," the authors wrote, noting that they are developing an educational intervention with funding from the American Board of Internal Medicine.

Medical schools and residency training programs have given increased attention to professionalism, and hospitalists have taken on a greater role as resident supervisors, according to the researchers. Thus, hospitalists may have an influence on the behaviors and views of professionalism of the residents.

To examine the frequency of unprofessional behaviors, Arora and colleagues performed a survey of internal medicine hospitalists in three academic health centers in Chicago  -  the University of Chicago Pritzker School of Medicine, Northwesten University Feinberg School of Medicine, and NorthShore University HealthSystem.

The researchers sent the 35-item survey to 101 hospitalists, and 77 responded. Survey participants were asked whether they participated in, or observed, a particular behavior and then asked to rate that behavior on a scale from 1 (unprofessional) to 5 (professional); responses of 'unprofessional' and 'somewhat unprofessional' were defined as unprofessional.

Nearly all of the behaviors included on the survey were rated as unprofessional or somewhat unprofessional, and only one behavior  -  staying past shift limit to complete a patient-care task that could have been signed out  -  was considered professional.

Consistent with previous studies, respondents who reported participating in certain unprofessional behaviors were less likely to identify them as unprofessional.

Most hospitalists said they had personal conversations in patient corridors and ordered tests as "urgent" to expedite care. About 40% also reported making fun of other physicians to colleagues and disparaging the emergency room team or outpatient doctors for incorrect findings.

The unprofessional behaviors fell into four larger categories, which accounted for 76% of survey variance:

  • Making fun of others
  • Learning environment (for example, texting during conferences or not correcting a patient who mistakes a student for a doctor)
  • Workload management (for example, celebrating a blocked admission or coming to work sick)
  • Time pressure (for example, backing up a resident's note without being confident about the content of the documentation)

Hospitalists with less clinical time were more apt to report making fun of others (P=0.004).

"It may be the case that hospitalists with more clinical time may make a larger effort to develop and maintain positive relationships," the researchers wrote. "Another possible explanation is that hospitalists with less clinical time are more easily influenced by those in the learning environment who make fun of others, such as residents who they are supervising for only a brief period."

Younger hospitalists and those who had any administrative time were more likely to report participating in workload management behaviors (P<0.05 for both).

"Our prior work shows that behaviors related to workload management are more widespread in residency, and therefore younger hospitalists, who are often recent residency graduates, may be more prone to participating in these behaviors," the authors wrote.

"While unproven, it is possible that those with more administrative time may have competing priorities with their administrative roles, which motivate them to more actively manage their workload, leading them to participate in workload management behaviors."

In addition, those who worked night shifts were more likely to report participating in time-pressure behaviors (P<0.05), which "could reflect the high workloads that night hospitalists may face and the pressure they feel to wrap up work, resulting in a hasty handoff (i.e., over the phone), or to defer work (i.e., family questions)."

Primary source: Journal of Hospital Medicine            

Source reference: Reddy S, et al "Participation in unprofessional behaviors among hospitalists: a multicenter study" J Hosp Med 2012; DOI: 10.1002/jhm.1946.

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